Bali Vishal, Holmes Holly M, Johnson Michael L, Chen Hua, Fleming Marc L, Aparasu Rajender R
Health Advocate, Westlake Village, California.
Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
Pharmacotherapy. 2016 Jan;36(1):38-48. doi: 10.1002/phar.1680. Epub 2016 Jan 9.
Second-generation antidepressants have been shown to improve cognition and depression symptomatology, which are the major risk factors for dementia; however, little is known about the comparative effectiveness of antidepressants in reducing the risk of dementia. Thus, the objective of this study was to evaluate the long-term comparative effectiveness of different antidepressant classes in reducing the risk of dementia in elderly nursing home residents with depression.
Propensity score-adjusted retrospective cohort study.
Multistate Minimum Data Set-linked Medicare Parts A, B, and D data files.
A total of 25,108 nursing home residents (65 years and older) with a diagnosis of depression and without a dementia diagnosis who were Medicare beneficiaries and new users of selective serotonin reuptake inhibitors (SSRIs; 19,952 [79.5%]), serotonin-norepinephrine reuptake inhibitors (SNRIs; 2381 [9.5%]), or tetracyclic antidepressants (2775 [11.1%]) between 2007 and 2010.
New users of SSRIs, SNRIs, and tetracyclics were followed over a 2-year period for the occurrence of dementia. A Cox proportional hazards regression model was used to evaluate the comparative effectiveness of SNRIs and tetracyclics in reducing the risk of dementia, with the SSRI class used as the reference category after controlling for propensity scores and their interactions terms. The unadjusted incidence of dementia was 8.2% for SSRI users, 6.0% for SNRI users, and 7.2% for tetracyclic users. The propensity score-adjusted Cox model did not find any significant difference in the risk of dementia in elderly nursing home residents who used SNRIs (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.84-1.19) or tetracyclics (HR 1.01, 95% CI 0.87-1.17) compared with the SSRI users.
This study did not find any significant differences in reducing the risk of dementia among the new users of second-generation antidepressant classes. Further studies are needed to evaluate the profiles of second-generation antidepressants on cognition in this vulnerable population.
第二代抗抑郁药已被证明可改善认知和抑郁症状，而认知和抑郁症状是痴呆症的主要危险因素；然而，关于抗抑郁药在降低痴呆症风险方面的相对有效性知之甚少。因此，本研究的目的是评估不同类别的抗抑郁药在降低老年抑郁症疗养院居民患痴呆症风险方面的长期相对有效性。
倾向评分调整后的回顾性队列研究。
与多州最小数据集相关联的医疗保险A、B和D部分数据文件。
共有25108名疗养院居民（65岁及以上），他们被诊断患有抑郁症且无痴呆症诊断，是医疗保险受益人，并且在2007年至2010年间首次使用选择性5-羟色胺再摄取抑制剂（SSRI；19952人[79.5%]）、5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI；2381人[9.5%]）或四环类抗抑郁药（2775人[11.1%]）。
对SSRI、SNRI和四环类抗抑郁药的新使用者进行为期2年的随访，观察痴呆症的发生情况。使用Cox比例风险回归模型评估SNRI和四环类抗抑郁药在降低痴呆症风险方面的相对有效性，在控制倾向评分及其交互项后，将SSRI类作为参照类别。SSRI使用者痴呆症的未调整发病率为8.2%，SNRI使用者为6.0%，四环类抗抑郁药使用者为7.2%。倾向评分调整后的Cox模型未发现使用SNRI（风险比[HR]0.99，95%置信区间[CI]0.84-1.19）或四环类抗抑郁药（HR 1.01，95%CI 0.87-1.17）的老年疗养院居民患痴呆症的风险与使用SSRI的居民有任何显著差异。
本研究未发现第二代抗抑郁药新使用者在降低痴呆症风险方面有任何显著差异。需要进一步研究来评估第二代抗抑郁药对这一弱势群体认知的影响。
